Infections of Larynx and Epiglottis

Question 1

Laryngitis

Answer 1

= inflammation on and around larynx causing hoarseness or harshness of the voice

etiology:

• any inflammatory process involving larynx; can be caused by variety of infectious and noninfectious processes
• majority cases seen in clinical practice in developed countries are acute
• acute laryngitis common syndrome caused predominantly by same viruses responsible for mony other URIs
  
  • most cases occur in setting of viral URI; nearly all major respiratory viruses have been implicated in acute viral laryngitis
    
    • rhinovirus, influenza virus, parainfluenza virus, adenovirus, coxsakievirus, coronavirus, and RSV
  • acute laryngitis can also be ass w/ acute bacterial respiratory infections such as those caused by:
    
    • Group A Strep or C. diphtheriae
    • M. catarrhalis
• chronic laryngitis of infectious etiology is much less common in developed than in developing countries
  
  • laryngitis caused by Mycobacterium tuberculosis is often hard to distinguish from laryngeal cancer due to absence of signs, sxs, and radiographic findings typical of pulm disease
• Histoplasma and Blastomyces may be cause, often as complication of systemic infeciton
• Candida species, often in ass w/ thrush or esophagitis and particularly in immunosuppressed pts
• rarely due to Coccidioides and Cryptococcus
• consider inhaled irritants and neoplam (if chronic) as well

S:

• hoarseness and reduced vocal pitch or aphonia
• acute (usually by respiratory viruses) may also have: rhinorrhea, nasal congestion, cough, sore throat

O:

• direct laryngoscopy often reveals diffuse laryngeal erythema and edema along w/ vascular engorgement of vocal folds
• chronic disease (ie TB laryngitis) often includes mucosal nodules and ulcerations visible on laryngoscopy
  
  • these lesions sometimes mistaken for laryngeal cancer

P/TX:

• acute is treated w/ humidification and voice rest alone, hydrate
  
  • abx not recommended except when Group A Strep is cx (PCN then is choice)
• chronic: tx depends on pathogen, whose identification usually requires bx with cx
• laryngeal tuberculosis is highly contagious b/c of large number of organisms that are easily aeosolized; these pt should be managed same way as pts w/ active pulmonary disease